TREATMENT

Viral Meningoencephalitis
TREATMENT
Tx of viral meningoencephalitis is supportive, w/ the exception of
the use of acyclovir for HSV encephalitis .
Tx of mild disease may require only symptomatic relief.
Headache & hyperesthesia are treated w/ rest, nonaspirin-
containing analgesics, and a reduction in room light, noise, &
visitors.
Acetaminophen is recommended for fever.
Codeine, morphine, and the phenothiazine derivatives may be
necessary for pain & vomiting, but if possible, their use in
children should be minimized because they may induce
misleading signs & symptoms.
IV fluids are occasionally necessary because of poor oral intake.
More severe disease may require hospitalization & intensive
care.
TREATMENT
It is important to anticipate and be prepared to manage
convulsions, cerebral edema, inadequate respiratory
exchange, disturbed fluid and electrolyte balance,
aspiration & asphyxia, & cardiac or respiratory arrest of
central origin.
Therefore, patients with severe encephalitis should be
monitored closely.
In pxs w/ evidence of increased ICP, placement of a
pressure transducer in the epidural space may be
indicated.
The risks of cardiac & respiratory failure or arrest are
high w/ severe dse
TREATMENT
All fluids, electrolytes, & medications are initially given
parenterally.
In prolonged states of coma, parenteral alimentation is
indicated.
SIADH is common in acute CNS disorders;
monitoring of serum sodium concentrations is required
for early detection
Normal blood levels of glucose, magnesium, & calcium
must be maintained to minimize the likelihood of
convulsions.
If cerebral edema or seizures become evident,
vigorous tx should be instituted.
PROGNOSIS
Supportive and rehabilitative efforts are very important
after patients recover.
Motor incoordination, convulsive disorders, total or partial
deafness, and behavioral disturbances may follow viral CNS
infections.
Visual disturbances due to chorioretinopathy & perceptual
amblyopia may also occur.
Special facilities & institutional placement may become
necessary.
Some sequelae of infection may be very subtle.
Therefore, neurodevelopmental and audiologic evaluations
should be part of the routine follow-up of children who have
recovered from viral meningoencephalitis.
PROGNOSIS
Most children completely recover from viral
infections of the CNS, although the prognosis
depends on the severity of the clinical illness,
the specific cause, and the age of the child.
If the clinical illness is severe and substantial
parenchymal involvement is evident, the
prognosis is poor, with potential deficits being
intellectual, motor, psychiatric, epileptic,
visual, or auditory in nature.
PROGNOSIS
Severe sequelae should also be anticipated in
those w/ infection caused by HSV.
Approximately 10% of children younger than
2 yr with enteroviral CNS infections suffer an
acute complication such as seizures,
increased ICP, or coma.
Almost all have favorable long-term
neurologic outcomes.
PREVENTION
Widespread use of effective viral vaccines for
polio, measles, mumps, rubella, & varicella has
almost eliminated CNS complications from these
diseases in the US
The availability of domestic animal vaccine
programs against rabies has reduced the
frequency of rabies encephalitis.
Control of encephalitis due to arboviruses has
been less successful because specific vaccines
for the arboviral diseases that occur in North
America are not available.
PREVENTION
Control of insect vectors by suitable spraying
methods and eradication of insect breeding
sites, however, reduces the incidence of these
infections.
Furthermore, minimizing mosquito bites
through the application of DEET-containing
insect repellents on exposed skin and wearing
long-sleeved shirts, long pants, and socks
when outdoors, especially at dawn and dusk,
reduces the risk of arboviral infection.